Excellent Care for All

The MRI/CT Decision Support Tool for Referring Physicians

Health Care Challenge

MRI and CT scans have proved powerful tools in diagnosing a range of pathologies. High demand for these technologies has led to wait times in Ontario. Unnecessary use of these diagnostic tools can impact negatively on wait times, patient safety and the overall burden of cost to the health care system.

In terms of patient safety, we know that CT scans can expose patients to 50 to 300 times the radiation of a chest x-ray. So avoiding CT scans that are not clinically warranted improves patient safety by reducing the exposure to a potential risk.

In terms of access and wait times, we know there is a huge demand for MRIs. “We have to ensure that people who need it the most get the appropriate access,” says Margie Sills-Maerov, performance improvement implementation consultant at the Ministry of Health and Long-Term Care. “We have focused on the supply side and the wait times for MRIs have not improved, we need to address the demand side.”

Real Change In Action

The ministry, in partnership with the University Health Network (UHN) and St. Joseph’s Healthcare Hamilton, has developed an online decision-making support tool to help physicians determine the appropriateness of ordering an MRI or CT scan.

This innovative tool analyzes case-specific clinical information provided by a physician and rates the appropriateness of using an MRI or CT scan as a diagnostic tool in light of current evidence-based guidelines.

UHN is launching a pilot within the hospital where the online tool will be incorporated in the physician diagnostic test ordering process. “If a physician orders a MRI for a condition outside the guidelines, the tool will tell them that this diagnostic tool is not typically recommended in this instance, “ Sills-Maerov says. “It will allow physicians to reflect on whether they are ordering tests that are not clinically useful in a given situation.” The results of the pilot will be evaluated and inform next steps, she adds.

The MRI/CT scan decision support tool will also be tested within the community in a number of Family Health Teams (FHTs).

The online tool has a database of approximately 1,000 clinical indications. Search results inform the physician if :

Either an MRI or CT scan is indicated for the condition in question

Whether one technology is preferred over another

Further consultation with a radiologist is recommended

There is no clinical evidence to support the use of these diagnostic tools.

Better Quality, Sustainable Care

The MRI/CT scan decision support tool will contribute to requests for these diagnostic tests being made based on consistent and robust Ontario guidelines. It will improve patient safety by eliminating unnecessary tests and free up critical resources for patients who are in need, thus improving wait times for MRIs and CT scans.

Using the appropriate health care resource at the appropriate time is an important part of delivering better quality care to Ontarians and supporting a sustainable system.